Uterine fibroids, medically known as leiomyomas, are common, non-cancerous growths that develop from the muscle tissue of the uterus. While most women experience common symptoms like heavy menstrual bleeding or pelvic pressure, these growths can sometimes undergo acute changes. Understanding these acute events, such as rupture, is important for recognizing signs that require immediate medical attention.
Understanding the Rupture Event
A true fibroid rupture, involving hemorrhage from a vessel on the fibroid’s surface, is extremely rare. The more common acute event producing similar, severe symptoms is torsion. Torsion occurs when a pedunculated fibroid, attached to the uterus by a stalk, twists on its axis. This twisting motion cuts off the fibroid’s blood supply, leading to infarction or tissue death. This acute degeneration triggers sudden, severe pain that mimics a rupture. Less commonly, a fibroid may hemorrhage into the abdominal cavity, a condition called hemoperitoneum, which can be life-threatening due to rapid blood loss.
Identifying Acute Symptoms
The symptoms of a fibroid rupture or torsion are sudden and severe. The most immediate sign is the abrupt onset of intense, localized pain in the pelvis or abdomen. Patients often describe this as the worst pain they have ever experienced, and it does not resolve with typical pain relief measures.
If the event involves significant internal bleeding, the patient may show signs of hypovolemic shock, such as a rapid heart rate, low blood pressure, and cold, clammy skin. Torsion or infarction can also lead to systemic inflammation, presenting with a low-grade fever and an elevated white blood cell count. Furthermore, acute irritation of the abdominal lining can cause a rigid or tender abdomen, often accompanied by persistent nausea and vomiting. Any combination of these acute symptoms necessitates an immediate visit to an emergency department.
Emergency Treatment and Medical Care
Upon arrival at the emergency room, the immediate priority is patient stabilization. Intravenous fluids are administered to address potential shock or dehydration, and powerful pain medication is given to manage the severe discomfort. Diagnostic imaging is then utilized to confirm the cause of the acute abdomen and differentiate it from other gynecologic or gastrointestinal emergencies.
An ultrasound or CT scan is performed to visualize the fibroid, detect signs of compromised blood flow, and identify free fluid in the abdominal cavity. A characteristic sign of torsion on imaging is the “dark fan” sign, showing an area of poor contrast enhancement due to lack of blood flow. The definitive treatment for a torsed or ruptured fibroid is almost always surgical intervention.
The primary goal of surgery is to remove the source of the acute complication and prevent further blood loss or infection. Surgeons typically perform a myomectomy, which is the removal of the specific compromised fibroid. In extremely severe cases involving massive hemorrhage, uncontrolled infection, or extensive damage, a hysterectomy (removal of the entire uterus) may be required to save the patient’s life.
Specific Risk Factors
Certain characteristics and specific patient conditions increase the likelihood of torsion or a rupture-like event. The most significant risk factor is the presence of a pedunculated fibroid, which is attached to the uterus by a narrow stalk. This stalk allows the fibroid to move freely, making it vulnerable to twisting and torsion.
Fibroids greater than 10 centimeters are also at a higher risk of complications, including rupture, due to increased demand on their blood supply. External forces, such as abdominal trauma, can rarely cause a fibroid to tear away from the uterine wall, leading to sudden bleeding.
Pregnancy is another factor that increases risk, as the rapid growth of the uterus and hormonal changes can cause congestion and subsequent fibroid degeneration.